Interrogatories - Injury Report

Text in this Example:

1. Do you own any interest in real estate?if so, as to each such interest, state:(a).the location of the real estate(b).the nature of your interest in the real estate(c).the date you acquired such interest(d).the amount which you paid to acquire such interest(e).whether there are any mortgages on such real estate. If there are any such mortgages, as to each mortgage, state:i).the identity of the mortgageii).the amount of the original mortgage obligationiii).the outstanding obligations of the mortgage2. Have you conveyed any interest in any real estate to anyone within the last 12 months?If so, as to each such conveyance, state:the description of the real estatethe interest which you conveyedthe identity of the person to whom you conveyed that interestthe consideration which you received3. Do you hold as mortgagee a mortgage in any real estate?If so, as to each such mortgage, state:the date on which you acquired the mortgagethe original principal amount of the mortgagethe outstanding balance due on the mortgagethe identity of the mortgagor4. Do you own any automobiles, trucks, vessels, aircraft, or other vehicles?If so, as to each such vehicle, state:the make, model, and year of the vehiclethe identity of the registered owner of the vehiclethe governmental agency registering the vehicle and the registration numberthe location of the vehicle5. Is anyone indebted to you in amount in excess of $100.00?if so, as to each such indebtedness, state:the identity of the individual or entity which is indebted to youthe amount of such indebtednessthe date on which the indebtedness is dueInterrogatories6. Do you have any savings, money market, or checking accounts, or certificates of deposit?If so, as to each such account or certificate, state:the identity of the depository institution for the account or certificate of depositthe title and registered owner or holder of the account or certificate of depositthe current balance of the account or certificate of deposit7. Do you have or use any safe deposit box or other similar storage facility?If so, as to each such facility, state:the identity of the institution in which you rent, lease, or use such a facilitythe box or other identifying number for such facilitythe name under which such facility is rented, leased, or usedthe contents of such facility8. Do you own or have any interest in any stocks, bonds, mutual funds, money market funds, or other securities or negotiable instruments?If so, as to each such interest, state:a full description of the stock, bond, security, or negotiable instrumentthe par or face value of such stock bond, security, or negotiable instrumentthe registered and beneficial holders of the stock certificate, bond, security, or negotiable instrumentthe dates on which interest or dividends are payablethe maturity date of any bond(f).the identity of the custodian of any and all documents evidencing the interest(g).the location of any and all such documents9. Do you own any jewelry, furniture, office equipment, precious metals or stones, television sets, radios, record players, antiques or collectibles, electrical appliances, power or hand tools, photographic equipment, works of art, furs, musical instrument, rare books or map, collections of coins or stamps, silver or china, or other personality with an individual or collective value exceeding $250.00?If so, as to each such item, state:a full and complete description of such item and its present conditionthe location of such itemwhether or not such item is subject to any security interestthe identity of the holder of any such interest10. Are you a beneficiary of any trust fund?If so, as to each trust fund, state:the nature of the trustthe nature of your interest thereinthe identity of each trustee11. Do you own any patents, inventions, trade names, trade secrets, trademarks, service marks, or copyright?a full and complete description of each itemthe number of any other identifying features of such item12. Do you own any warehouse receipts, bills of lading, or other documents of title?the identity of such itemwhether or not such item is subject to any such security interestthe identity of the holder of any such security interest13. Are you the plaintiff in any lawsuit which pending or in which a verdict of judgment has not been satisfied in whole or part?14. Have you applied for a loan or mortgage within the last three years?If so, as to each such loan or mortgage application, state:where you applied for such loanwhether or not you were granted such loanthe amount granted for such loanwhat you did with the proceeds of such loan, if any15. In the last three years, have you acted as co-maker, guarantor, or endorser of any loan? If so, provide full details as to each such loan and your relationship thereto, including the amount of the loan.16. Have you issued or furnished any financial statements within the last three years?If so, as to each such financial statement, state:the identity of such financial statementto whom such financial statement was issued17. Are you a party to a contract of any kind? If so, as to each such contract, state:the identity of such contractthe nature of such contractthe identity of the person or entity with whom you entered into the contract18. Does any governmental body owe you any money? If so, provide full and complete details thereof.19. Have you made any claim under any policy of insurance within the last three years?If so, as to each such claim, state:the name of the insurerthe policy numberthe facts given rise to such claimwhether or not such claim has been paid20. Do you own or have interest in any partnerships or limited partnerships?a full and complete description of the partnership or limited partnership, including but not limited to, its name, purpose, assets, registered address, and the identity of each of its general partnersthe identity of the agreement or agreements governing the affairs of the partnershipthe nature and extent of the interestthe value of the interest, if anythe name under which the interest is owned or otherwise held by you21. Do you own or have any interest in any business, corporation, partnership, or joint venture other than those identified in responses to the foregoing interrogatories?If so, as to each, state:the identity of the business, corporation, partnership, or joint venturea full and complete description of you interest in same22. Do you own or have interest in any asset or item of value individually or collectively worth in excess of $500.00 other than those identified in response to the foregoing interrogatories?If so, as to each such asset or item, state:a full and complete description of the asset or itemthe nature of your interest in the assets or itemthe value of the asset or item23. Are you unable to pay any of your debts or obligations? If so, provide full and complete details thereof.IMA LAWYERAttorney for Plaintiff